Selective serotonin reuptake inhibitors and malformations: case closed?

Area of Science:

• Perinatal mental health
• Pharmacovigilance
• Reproductive medicine

Background:

• Selective serotonin reuptuptake inhibitors (SSRIs) are frequently prescribed to pregnant women for depression.
• Previous studies suggested a potential link between SSRI use during pregnancy and increased risk of infant cardiac malformations.
• This has raised concerns among patients and clinicians, potentially leading to treatment cessation.

Purpose of the Study:

• To evaluate the association between SSRI use in pregnancy and the risk of congenital cardiac malformations.
• To address the concerns and anxiety surrounding SSRI use during pregnancy.

Main Methods:

• Analysis of administrative databases.
• Comparison of cardiac malformation rates in infants exposed to SSRIs versus unexposed infants.
• Consideration of maternal depression as a confounding factor.

Main Results:

• Recent evidence indicates a similar increased risk of cardiac malformations in infants of depressed mothers not using SSRIs.
• Ascertainment bias, due to increased diagnostic testing in depressed women (treated or untreated), is proposed as the likely explanation.
• Data suggest SSRIs do not elevate the risk of cardiovascular malformations.

Conclusions:

• The observed association between SSRI use and cardiac malformations is likely due to ascertainment bias, not a direct effect of SSRIs.
• Pregnant women with depression can be reassured regarding the cardiovascular safety of SSRIs.
• Continued use of necessary SSRI therapy during pregnancy is supported by current evidence.